08060225 (2) CITY OF CUPERTINO
BUILDINO DIVISION PERMIT CONTRACTORINFORMAJQN,7
PERMR NO.
BUILDIpLOApLp96RESTON DR FAST WATER HEATER 08060225
OWNER'S JNA25MEE: 1, PTRMIT ISSUE DATE
WESSLER LOUIS E & MARIE— 12601 132 AVE NE 06/26/2008
JW
(800) 454-8955 SANRARY NO. CONTROL NO.
ARCHITECUFNGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 t�
goo LICENSED CONTRACTOR'S DECLARATION Job Description
W 1 Webby affirm Wt Ilam licensed under Pmvitions of Chapter 9(commencing
! �
whin Smsion7IXXBofDiviaton3oftheBut.And ProkssimsCak.And myfic..i, RMV/RPLC GAS WATER HEATER
- ve In full force And effect,
p q? License Clan LIC.as
F 0 DataContranar
ARCHITECTS DECLARATION
22 I uMcnsand my plants NWI be used as public record,
�yV
�LLo� Licensed Professional
sZ3 OWNErn exempt Indian
<C I W rtby alarm that 11. ucmpr from the Contractor's :Anse Law for the
i❑O following mason.(Section BI3 t,5,Business and w,de ons Calc:Any city as manly
which myuimu a permit to constquires the
altar.impmw,h permit t fie a sig any Nmmum
-iy
prior miu ceased c,marmgo the thof forsucthe CohmrmittLidenc Law(ed lammcnt
<
ERsthus becneingsedpSection7 the Provisions of the eBuSmsandPrtClaw(Chapsv9 Sq.Ft.Floor Area Valuation
(hatMis ngwiHSmaromanddidbasisfrmfth iledexemton.MynsCode)of $449
Q Nati b exempt therefrom and or hash for the,alleged exemption.Any violation of
SeNon 7031.5 five
any applicant for a permit mbjau lW applkm m a civil penalty of Number Occu enc Type—
An.
nmthanfiwWnamadollam(SSW). 32637045 .E P Y
1,utawcerk.And
pmpaty,on Is otimarcu wildwage uJk,(=.c0mpensatian,
will de fi amok,andthe he Combmsmu:Mcda Law
fmsa Apply 0N,..or of
ass
Add ProwhoW Cads:The Contrmmr,License Taw docs rot apply lf rt owner of Required Inspections
mw am who Wilda ided t ansa HeImpro add ausmh work himaelfar through his
however.
the
pr such Improvements art not earnded ofo meQefed ficarMe Baia r-
builder the Wildingor uimprovemmramid within oto year m improve
Ne owe of
builder will haw Jon Burda of proving Nu be did tot Wild a improve Ter purpose of
umJ.
of..owner of He Property.am a.lusively contracting with licensed conuxmn to
construct He pmjea(Sec.7(t44,Business Audi Profcuime,Code:)M Contractors U. .
Cense law does not apply to as owner of prupen,who Wilds of improves therm,rod,
who cmuacu for such projects;Aruba.eonuactm(s)licensed pmumnt m the Cmuanora
License Law.
O l oto eaemptunda See .B B P C for Hu rtamn '
Owne Data
WORKER'S COMPENSATION DECLARATION
I hereby a(nrm under penally of perjury ma:of tbe following dobe Worts
❑1 hive and will mainum a Certirra¢of Conant in self-insure for Workers Camper.
salon,As provided for by Section 3700 of the Labour Code,fm the performance of the
wmk for which His Permit b'..,ad.
❑1 have and will maintain Workers Compensation Insurance,As required by Section
37W of dno Latta Code,far the performance of tbe work for which this Perris u issued.
My Wmk`,Compensation lemunee carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF HEMP ION FROM WORKERS'
COMPENSATION INSURANCE
Cfhb Method need nor W completad if the permit is forma hundred dollar;(SIM)
or less)
I comfy that in the performance of the work for which this permit is issued.I shall not
employ any person in any manmrso As in become object ton tW Wmrken'CompeosWw
Laws of Califomia Dam
Applicant
NOTICE TO APPLICANP.If.after making this Cenifiuta of Exemption.you should
become subject to tbe Worker's Canpeasation provisions of the tabor Code.you must
.JO forthwith comply wit such Provisions m Hb permit shall W deemcrl rooked. '
z rn CONSTRUCTION LENDING AGENCY
(-+ I bereby affirm lbs Heti b a construction lending agency for the performance of
fix,7 the work fur which this permit Is issued(Sce.3097,Civ.C.) '
QLenders Name .
=z Lenders Address
V 0 1 mnify that 1 haw rad this application and sum Hat the above information is
U. mrtca 1 agree m Comply with all City and Cooly om iMMM and stile laws relating m
0 Wilding conumcuam and hereby mthori,a rtpmscnutivu of this city to enter upon tW
LU
above-menuonnd property fan n i eperams pooches
�„6r (We)agree to taw,indemnify and keep harmless the City of Captain.against
Z in consequence
caumd of this
MAY in any way because against said City
V 2 in eansegmnee of He granting of His permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
S4��
Signature of ApplicanUConuacmr Dam Re-roofs
xezARDDUR MATERIALS DISCLOSURE Type of Roof
Will
yt e,C.penior forum Wildingecapmt amu2. ad ehvallousmaterial
Cr de.See by 25 Cupertino Municipal Conde,Chapter 9.13,antl the Health anti Safety
Crude.steam 2ss32(a)?
❑ons ON. All roofs shall be inspected prior to any roofing material being installed.
Will He applicant or future Wilding mea anal me If a roof is installed without first obtainingan inspection,I agree to remove
PP l p equipment m devices which P
tett hmaNnus air conuminanu u defined by the Bay Arta Air Quality Mmagcmcnt all new materials for inspection.
\`Ji,v a?
❑Yes 0 N
I have mad the haardms manorial,mCuimmenu under Chapter 6.95 or the coifor.
ria Health k Safety Cade.Sections 25505,25533 and 25534.Iundcuund teatime Wilding
docs not Currently have a umme.that it b my nu ounbri sty m mJfy tic occupant of the
requirements which on.be nnoI prior to issuarcc of a Cenificam of Occupancy.
Signature of Applicant Date
Owner or audumbod agent D,no- I All roof coverings to be Class'A"or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32637045 . 00
DATE ISSUED. . . . . . . : 06/26/2008
RECEIPT # . . . . . . . . . : BS000005228
REFERENCE ID # . . . : 08060225
SITE ADDRESS . . . . . : 10380 CRESTON DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WESSLER LOUIS E & MARIE-GENEVI
ADDRESS . . . . . . . . . . : 10380 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014
RECEIVED FROM . . . . : JEFF JORDAN
CONTRACTOR . . . . . . . : JEFF JORDAN LIC # 29100
COMPANY . . . . . . . . . . : FAST WATER HEATER
ADDRESS . . . . . . . . . . : 12601 132 AVE NE
CITY/STATE/ZIP . . . : KIRKLAND, WA 98034
TELEPHONE . . . . . . . . : (800) 454-8955
•
FEE IO UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ - ------------ ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 449 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0. 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 .48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0 .00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 106'. 56 VISA
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
Permit No: 060/_ o�5407720
(office use only)) �P
City Of Cupertino Building Permit Application
E-Mail: Building-Permitsi7cupertiino.org (Address is case sensitive).
Jobsite Address:lo380 CRESTON DR Date: 6/25/08
Assessor's Parcel Number. 3Z 63-7 oyS,O O
Owners Name: WESSLER, ED Phone No: (408)245-7113
Project Valuation: 449.00
Building Permit Info: Bldg Elect Plumb x Mach
Job Description
Remove/Replace Gas Water Heater
Contractor Information
Company Name: FAST WATER HEATER COMPANY Phone No:
• Contact Name: Carol Randall Fax No: 800-454-8955
Address: 12601 132ND AVE NE E-mail:carolr@fastwaterheater.com
City, State &Zip code: KIRKLAND,WA 98034
State Contractor's Lie. No: 877489 Expiration Date: 5/31/10
Worker's Comp No: 1761660 Expiration Date: 12/1/08
Carrier California State Fund
Ci of Cupertino Business License No: 29100
Credit Card Information
Credit Card No: 4417123041349530.
Expiration Date: 11/10
Name on Card: Jeff Jordan
Visa ® MasterCard ❑ American Express ❑
The Building permit application and a completed & signed
• contractor/subcontractor form need to be submitted with each permit.
i
Community Development
10300 Torre Avenue
Cupertiuo CA 95014
Telephone(408)777-3228
F Fax(408)777-3333
OCUPEkTINO
Builffing Department
JOB ADDRESS: 10380 CRESTON DR PERMIT#
OSo(� oaas
OWNER'S NAME: WESSLER, ED PHONE# 408)245-7113
GENERAL.CONTRACTOR FAST WATER HEATER COMPAN FAX# 425-814-9516
I am not using any subcontractors:_ �'` 6/25/08
Signature Date
Please check applicable subcontractors and complete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&M11work
Cement Finishing
Electrical
Excavation
Fencing
Flooring.Carpeting
Linoleum/Wood
Glass/Glazing
• Heating
Insulation
Landscapin
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
•
1